Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care.

This paper argues that a dialectical synthesis of phenomenology's traditional twin roles in psychiatry (one science-centered, the other individual-centered) is needed to support the recovery-oriented practice that is at the heart of contemporary person-centered mental health care. The paper is in two main sections. Section I illustrates the different ways in which phenomenology's two roles have played out over three significant periods of the history of phenomenology in 20th century psychiatry: with the introduction of phenomenology in Karl Jaspers' General Psychopathology in 1913; with the development a few years later of structural phenomenological psychopathology; and in the period of post-War humanism. Section II is concerned with the role of phenomenology in contemporary mental health. There has been a turn to phenomenology in the current period, we argue, in response to what amounts to an uncoupling of academic psychiatry from front-line clinical care. Corresponding with the two roles of phenomenology, this uncoupling has both scientific aspects and clinical aspects. The latter, we suggest, is most fully expressed in a new model of "recovery," defined, not by the values of professionals as experts-by-training, but by the values of patients and carers as experts-by-experience, specifically, by what is important to the quality of life of the individual concerned in the situation in question. We illustrate the importance of recovery, so defined, and the challenges raised by it for both the evidence-base and the values-base of clinical decision-making, with brief clinical vignettes. It is to these challenges we argue, that phenomenology through a synthesis of its twin roles is uniquely equipped to respond. Noting, however, the many barriers to such a synthesis, we argue that in the current state of development of the field, it is by way of a dialectical synthesis of phenomenology's roles that we should proceed. From such a dialectic, a genuine synthesis of roles may ultimately emerge. We conclude with a note on the wider significance of these developments, arguing that contrary to 20th century stereotypes, they show psychiatry to be leading the way for healthcare as a whole, in developing the resources for 21st century person-centered clinical care.

Montgomery and shared decision-making: implications for good psychiatric practice.

The 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.Declaration of interestNone.

Search terms and a validated brief search filter to retrieve publications on health-related values in Medline: a word frequency analysis study.

OBJECTIVE: Healthcare debates and policy developments are increasingly concerned with a broad range of values-related areas. These include not only ethical, moral, religious, and other types of values 'proper', but also beliefs, preferences, experiences, choices, satisfaction, quality of life, etc. Research on such issues may be difficult to retrieve. This study used word frequency analysis to generate a broad pool of search terms and a brief filter to facilitate relevant searches in bibliographic databases. METHODS: Word frequency analysis for 'values terms' was performed on citations on diabetes, obesity, dementia, and schizophrenia (Medline; 2004-2006; 4440 citations; 1,110,291 words). Concordance® and SPSS 14.0 were used. Text words and MeSH terms of high frequency and precision were compiled into a search filter. It was validated on datasets of citations on dentistry and food hypersensitivity. RESULTS: 144 unique text words and 124 unique MeSH terms of moderate and high frequency (≥ 20) and very high precision (≥ 90%) were identified. Of these, 19 text words and seven MeSH terms were compiled into a 'brief values filter'. In the derivation dataset, it had a sensitivity of 76.8% and precision of 86.8%. In the validation datasets, its sensitivity and precision were, respectively, 70.1% and 63.6% (food hypersensitivity) and 47.1% and 82.6% (dentistry). CONCLUSIONS: This study provided a varied pool of search terms and a simple and highly effective tool for retrieving publications on health-related values. Further work is required to facilitate access to such research and enhance its chances of being translated into practice, policy, and service improvements.

Bringing together values-based and evidence-based medicine: UK Department of Health Initiatives in the 'Personalization' of Care.

RATIONALE: Person-centred medicine depends on combining best research evidence with the unique values (including the preferences, concerns, needs and wishes) of individual patients and their families. AIMS AND OBJECTIVES: The paper gives a brief introduction to values-based practice as a new approach to incorporating patients' values into clinical decision making alongside best research evidence as derived from evidence-based practice. METHOD: The role of values-based practice as a partner to evidence-based practice is illustrated through a series of policy, training and service development initiatives in mental health from the UK Department of Health in London. RESULTS: These initiatives have supported person-centred developments in key areas of mental health practice including, (1) the use of involuntary treatment; and (2) a shared approach of assessment. Early moves are underway to extend values-based practice to other areas of health care beyond mental health. CONCLUSION: Values-based practice offers a new approach to incorporating patients' unique values into clinical decision making that is complementary to evidence-based practice as a resource for person-centred medicine.

Understanding the clinical concept of delusion: from an estranged to an engaged epistemology.

Delusion is relatively easy to diagnose but near impossible to define. This paper (I) uses the method of 'philosophical fieldwork' to show that standard approaches use definitions that are both over- and under-inclusive. It argues furthermore that such approaches typically presuppose what is here dubbed an 'estranged' epistemology. This epistemology supposes that our understanding of the world occurs outside of, and consequent on, our experience of it. Instead of this an alternative 'engaged' epistemology is set out. This alternative sees experience itself as the vehicle of our most fundamental comprehending engagement with the world. (II) This, it is argued, makes better sense both of our contact with reality and of the failure of this contact in delusion. (III) The implications of this alternative theorisation for the cognitive psychology of delusion are discussed.